Cost-effectiveness analysis of neoadjuvant chemoradiotherapy followed by surgery versus surgery alone for locally advanced esophageal squamous cell carcinoma based on the NEOCRTEC5010 trial
Cost-effectiveness analysis of neoadjuvant chemoradiotherapy followed by surgery versus surgery alone for locally advanced esophageal squamous cell carcinoma based on the NEOCRTEC5010 trial
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DOI：
10.1016/j.radonc.2019.07.031
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发表时间：
2019-12-01
影响因子：
5.7
通讯作者：
Li, Qiu
中科院分区：
文献类型：
--
作者：
Zhan, Mei;Zheng, Hanrui;Li, Qiu
背景和目的：NEOCRTEC5010期试验表明，新辅助放化疗(NCRT)加手术治疗局部晚期食管鳞癌(ESCC)的疗效明显优于单纯手术，但同时NCRT的加入也给患者带来了经济负担。本研究基于NEOCRTEC5010试验对NCRT加手术的成本-效果进行了评估。材料和方法：使用基于NEOCRTEC5010试验数据的三态马尔可夫模型(无病生存、复发和死亡)来估计NCRT加手术与单纯手术治疗ESCC的增量成本-效果比(ICER)。该模型从中国社会的角度对结果进行评估。计算了成本、质量调整寿命年(QALY)以及以2019美元/QALY收益表示的ICER。结果：与单纯手术相比，NCRT加手术增加了14933.57美元的成本，同时获得了3.08QALY，导致ICER为4848.56美元/QALY。ICER远远低于普遍接受的支付意愿门槛(每QALY 26,157美元)。接受NCRT的患者的无病生存时间(DFS)是决定ICER的关键因素。结论：与单纯手术相比，NCRT后手术治疗局部晚期ESCC具有显著的临床益处，具有成本效益。(C)2019爱思唯尔B.V.保留所有权利。
Background and purpose: The phase 3 NEOCRTEC5010 trial demonstrated that neoadjuvant chemoradiotherapy (NCRT) plus surgery for locally advanced esophageal squamous cell carcinoma (ESCC) had significantly greater efficacy than surgery alone did, but at the same time, the addition of NCRT places an economic burden on patients. This study assessed the cost-effectiveness of NCRT followed by surgery based on the NEOCRTEC5010 trial.Materials and methods: A three-state Markov model (disease-free survival, relapse and death) based on data from the NEOCRTEC5010 trial was used to estimate the incremental cost-effectiveness ratio (ICER) of NCRT plus surgery versus surgery alone for ESCC. The model evaluates the outcomes from the perspective of Chinese society. Costs, quality-adjusted life-years (QALYs), and the ICER in terms of 2019 US$ per QALY gained, were calculated. Model robustness was evaluated with one-way and probabilistic sensitivity analyses.Results: Compared with surgery alone, NCRT plus surgery increased costs by $14933.57, while gaining 3.08 QALYs, resulting in an ICER of $4848.56 per QALY. The ICER was far below the commonly accepted willingness-to-pay threshold ($26,157 per QALY). The duration of disease-free survival (DFS) for the group that received NCRT was the crucial factor in determining the ICER.Conclusion: Compared with surgery alone, NCRT followed by surgery for locally advanced ESCC can be cost-effective because of significant clinical benefits. (C) 2019 Elsevier B.V. All rights reserved.